Pyelonephritis is one of the most common diseases of the urinary system, which is inflammatory in nature. The disease occurs in people of different ages and is manifested by a number of unpleasant symptoms. As an exacerbation of chronic pyelonephritis manifests itself, the symptoms and treatment features of this disease will be discussed in detail below.
Features of the disease
Exacerbation of chronic pyelonephritis according to ICD-10 is encoded No. 11.1. This ailment is a consequence of the acute form of the disease. If he was treated incorrectly or if appropriate therapy was not carried out at all, the disease enters a chronic stage. It occurs if, 2-3 months after the onset of the acute form of pyelonephritis, recovery has not occurred.
Exacerbation of chronic pyelonephritis (according to ICD-10, the ailment code is 11.1), several specific deviations are diagnosed. One or both kidneys are reduced in size, acquire an uneven surface, which has sagging in places of scar tissue changes. Where areas of the kidney were not infected, there are protrusions.
In the chronic stage of this disease, the fibrous capsule thickens, and also it almost does not separate from the kidney tissue. This is caused by the occurrence of numerous adhesions. If the stage of the disease is advanced, the weight of the kidney decreases to about 50 g. There have been cases when it has lost even more weight. Due to the inflammatory process, the pelvis and calyx are somewhat enlarged, their walls are thickened. Their mucous membrane is sclerosed.
During both acute and chronic pyelonephritis on the tissues of the kidney (or both kidneys) there are foci of both healthy tissue and areas affected by the infection. A gradual scarring process also occurs. The death of the renal tubules occurs due to their defeat by infiltration and sclerosis.
At a late stage, glomeruli are also involved in the process, during which a decrease in filtration function occurs. Previously, concentration failure develops, a decrease in blood flow in the kidneys. Here arterial hypertension is observed.
Similar changes develop in the organ rather slowly. Therefore, the disease can last for many years, showing minor symptoms. First, diuresis appears, urine density decreases.
Stages
Chronic pyelonephritis in the acute stage is characterized by certain symptoms. However, it is worth considering this disease in a complex. So, there are 4 stages of chronic pyelonephritis. They are characterized by the following changes in the body:
- In the first stage, the glomeruli of the kidneys are not affected by the infection, they are not involved in the pathological process. But on the other hand, atrophy of the collecting tubules occurs actively. This process occurs evenly.
- In the second stage, the still neglecting and hyalinization of some glomeruli of the organ begins. The vessels are significantly narrowed, which leads to an increase in pressure in them. In the tubules, cicatricial-sclerotic changes are steadily increasing.
- Further, in the stage of exacerbation of chronic pyelonephritis, most glomeruli die. During the third stage of the disease, atrophy of the tubules is observed, and the connective tissue grows.
- In the last stage, most glomeruli die. Because of this, the organ is greatly losing in size. Healthy functional tissues are replaced by scars. The kidney becomes unable to perform its functions. This process is becoming irreversible.
For this reason, the sooner the correct, comprehensive treatment is started, the greater the patient's chances of recovery. Self-medication can be extremely dangerous. Therefore, when characteristic symptoms appear, you should consult a doctor as soon as possible.
Causes
There are many factors that can cause the development of chronic pyelonephritis. However, the cause for this disease is always the damage to the kidneys by microbes. They can be present in the human body without causing a disease. The activity of pathogenic microflora is growing due to various provoking factors.
Most often, infection with such microorganisms occurs:
- Escherichia coli or colic;
- enterococci;
- Pseudomonas aeruginosa;
- Proteus;
- other microbial associations.
Especially the development of the disease is affected by the appearance of microbes that are L-shaped and develop due to insufficient therapy when using antibiotics. Also, this process is significantly affected by a change in the acidity of urine.
Such microbes are resistant to many drugs, are difficult to diagnose, and can also be in the interstitial tissue for a long time. They are waiting for the right conditions to begin to actively proliferate again. It is acute inflammation of the kidneys that is the starting line for the development of a chronic form of the disease.
Exacerbation of chronic pyelonephritis in women can be caused by the onset of sexual activity, especially at an early age. During this period, one should not enter into intimacy regularly while a certain restructuring of the body occurs, and an increased load is placed on the immune system. An exacerbation of chronic pyelonephritis during pregnancy is also often diagnosed. Immunity at this time is reduced, which provokes the development of pathogenic microflora. Exacerbations occur immediately after birth.
In men, this happens against the background of the development of prostate adenoma.
Other reasons
In both sexes, the disease can be caused by late diagnosis, when the disease progresses significantly. Because of this, the outflow of urine is disturbed. Also, an exacerbation of the chronic form of the disease can be caused by urolithiasis, urinary tract diseases.
If the treatment regimen for the acute form of pyelonephritis was chosen incorrectly or prescribed too late, the disease becomes chronic. Incorrect use of antibiotics is especially dangerous. If you do not adhere to the established systemicity or take a lower dosage of the drug, microbial forms resistant to therapy develop. They can exist in organ tissues for a long time.
With any decrease in immunity, the likelihood of an exacerbation of pyelonephritis increases. In children, a similar condition occurs after suffering colds, measles, flu, etc. The presence of diabetes mellitus, chronic gastrointestinal tract pathologies, obesity and tonsillitis can trigger the growth of pathogenic microflora in the kidneys.
In some cases, the cause of the development of pathology are congenital anomalies of the urinary system that violate normal urodynamics. Also, the cooling of the body can have an effect on the growth of pathogenic microflora.
Symptomatology
During an exacerbation of chronic pyelonephritis, symptoms may be different. They depend on the place of development of the inflammatory process, the involvement of one or both kidneys, the presence of obstruction or concomitant infection.
The fact is that for many years the disease can proceed quite sluggishly. The period of remission can be almost devoid of discomfort. But during the period of exacerbation of chronic pyelonephritis, the symptoms become more pronounced. The following manifestations may be observed:
- a significant increase in temperature, which can reach 38-39º;
- lower back pain concentrated on one or both sides;
- dysuria;
- general weakness, poor health;
- loss of appetite;
- headache;
- abdominal pain, vomiting, nausea (more common in children);
- the face becomes a little puffy, swelling of the eyelids appears;
- pale skin, bags under the eyes (especially in the morning after sleep).
During remission, diagnosis is difficult. Symptoms during this period are mild or absent altogether.
Diagnostics
Considering the symptoms and treatment for exacerbation of chronic pyelonephritis, it is necessary to note the important role of a full diagnosis. Without it, therapy would not be effective. Diagnosis is complex, as the symptoms of pyelonephritis are like many other kidney diseases.
It will take a series of laboratory as well as instrumental examinations. If characteristic symptoms occur, the doctor prescribes to undergo the following diagnostic procedures:
- Analysis of urine. Allows you to determine the alkalinity of urine. It will be cloudy, while the density is reduced. The presence of bacteria may be observed, and the number of leukocytes increases.
- Blood analysis. If the disease is chronic, the patient develops anemia. Also, an increased content of leukocytes is determined, ESR increases. The blood formula shifts to the left.
- Sample Nechiporenko. This examination reveals the predominance of leukocytes over red blood cells, and active leukocytes will be detected in the urine in chronic pyelonephritis.
- Pyrogenal and prednisolone tests. The appropriate drug is administered to the patient. After that, several portions of urine are collected.
- Test according to Zimnitsky. Allows you to determine the decrease in density in different portions of urine. They are collected during the day.
- TANK. It is carried out with the aim of increasing the amount of sialic acids, fibrin, seromucoid, urea.
This list of studies is complemented by a series of instrumental surveys. Some of them must be carried out when symptoms of exacerbation of chronic pyelonephritis appear.
Instrumental diagnostic methods
To make a diagnosis of exacerbation of chronic pyelonephritis, appropriate instrumental examinations are also carried out. The doctor makes their choice:
- Panoramic x-ray of the kidneys. If the cause of the pain is a chronic form of pyelonephritis, the kidneys will be reduced in size (one or both).
- Chromocytoscopy. During this examination, excretory function of the kidneys is determined.
- Retrograde or excretory pyelography. The procedure allows to identify pathological changes or deformations of the calyx and pelvis of the organ.
- Ultrasound of the kidneys. It allows to detect asymmetry, heterogeneity of their structure and the presence of deformations.
- Radioisotope scanning. Allows you to identify changes in the configuration of the body, diffuse changes.
- CT or MRI. It is possible to examine in detail the structure of an organ with the help of similar modern examinations. They are characterized by the highest information content.
- Biopsy. A biopsy test is performed for difficult to diagnose cases of the disease.
Exacerbation of chronic pyelonephritis of the kidneys may be similar in symptoms to diseases such as amyloidosis of the kidneys, chronic glomerulonephritis, and diabetic glomerulosclerosis. Diagnosis allows you to establish the exact cause of the discomfort.
Treatment approach
Treatment of chronic pyelonephritis in the acute stage requires an individual approach to each patient. Only complex therapy can give a positive effect. The doctor prescribes not only drug treatment, but also prescribes the appropriate diet, drinking regimen. It will be necessary to eliminate the causes of improper outflow of urine.
With exacerbation of pyelonephritis, the patient is treated in a hospital. Appropriate monitoring and therapy is performed here. The duration of treatment depends on the neglect and characteristics of the course of the disease.
Particular attention is paid to the patient’s nutrition and drinking regimen. If swelling does not occur, the amount of fluid is not limited. But you only need to drink pure water, juices, fruit drinks and fortified drinks. You can drink 2 liters of fluid per day. If the patient is diagnosed with arterial hypertension, swelling, the amount of water is limited by the doctor. Salt intake is also limited. In some cases, salty foods are completely excluded from the diet.
An important aspect of treatment is the administration of appropriate antibiotics. They are taken for a long time. The drug is prescribed only after appropriate tests, which allow you to establish the sensitivity of microflora to a specific variety of drugs. It is strictly forbidden to take these drugs on your own. Otherwise, the microbes will become insensitive to antibiotics. This will greatly complicate the treatment.
Power Features
Diet with exacerbation of chronic pyelonephritis is an important factor that can accelerate recovery. It must be prescribed to all patients. Spicy foods, rich broths, flavor enhancers and seasonings are excluded from the diet. Alcohol and strong coffee and tea are prohibited.
Calorie intake remains the same. An adult should consume approximately 2300-2600 kcal per day. The diet must be balanced, include the necessary vitamins and minerals.
The optimal diet is the use of dairy and plant foods. The diet is supplemented with fish and meat. It is important to eat a variety of vegetables daily, such as cabbage, beets, potatoes. Eggs and fruits are also needed. Iron deficiency, which is often diagnosed with a chronic form of the disease, can be eliminated by eating beef, liver, apples, strawberries and pomegranates. A vegetarian diet is not appropriate in this case.
Prevention
In order to prevent the development of the disease, appropriate prevention of exacerbation of chronic pyelonephritis is carried out. Large physical activity is not recommended. It will be necessary to eliminate stress as much as possible. Subcooling must not be allowed. It is forbidden to work in hot shops, stand for a long time, go out into night shifts.
The diet should contain a minimum amount of salt. Identification and treatment of intercurrent diseases and latent infections. Periodically required treatment in a hospital setting.
Important correction of immunity, periodic treatment in the sanatoriums of the appropriate profile. A healthy lifestyle, proper nutrition, moderate exercise contribute to improving the general condition of the body, positively affecting, among other things, the kidneys.